"I've done the program for nine years, and it hasn't been until the last year and three-quarters that I've had a waiting list," said Karen Skizynski, director of Osceola County's Breast and Cervical Cancer Early Detection program.

The programs

Since 1990, the Centers for Disease Control has provided free and low-cost mammograms and pap smears to uninsured or underinsured women between 40 and 64 years old. In Florida, only women 50 to 64 years old qualify.

Although the number of women screened in Florida through this federal program has increased through the years, unemployment in women 55 to 64 years old has nearly doubled, from 3.4 percent in 2008 to 6.3 percent now.

Demand always has exceeded available services -- only 15 percent of eligible women get the breast exams, according to the CDC -- but the number of women who will now qualify for the free tests is expected to outstrip the funding provided by Congress. "Our aid stays the same, but all of a sudden there's a higher poverty level and they don't have health insurance," said Mary Bowers, director of the Florida Department of Health's program. "Until there's tremendous change funding-wise, there are very limited resources."

The department has nearly $5 million in funding for the current fiscal year, up about $350,000 from four years ago.

The cost

Conventional mammograms in Orlando can cost from $80 to $190. Digital mammograms cost between $125 and $247.

The clients

In Osceola County, Skizynski said many of the clients she sees now are undocumented women who lost their jobs in the service and hospitality industries. The unemployment rate for Hispanic women ages 55 to 64 was 6.2 percent higher this June than the same time last year, according to the most recent labor statistics.

Although Osceola screened more women this year than the department had budgeted for, 35 women had to wait until the new fiscal year began this month to get their screenings.

Local nonprofits such as Hispanic Health Initiatives, Shepherd's Hope and Sisters Network, which refer hundreds to health departments every year, are seeing new clients coming to them for guidance.

"Getting access to low-cost and free mammograms has always been an issue," said Sherlean Lee of Sisters Network, a breast-cancer survivor organization. "We're now getting more people who were employed that are no longer employed. We do a lot of health fairs and people tell us that they can't afford to pay for the price of one, and 'could we help?' "

The economy's effect

Another sign that unemployment is taking a toll on women's health, Skizynski said, is that fewer women are leaving the federally funded program.

"In years past, many women have obtained jobs with insurance and have left the program," she said. "This year, I'm not finding that. I'm finding my number of re-screens is higher . . . at least 10 percent over last year. And in that age group, that's kind of high."

The Seminole County Health Department, which offers the program for Orange and Lake counties as well, is already booked through August.

"If you don't have insurance, or if you can't afford a co-pay or deductible, that's a serious barrier to access," said Faye Wong of the CDC's Division of Cancer Prevention and Control. "If you keep in mind that health-care costs continue to rise, and therefore your dollars are stretched more thinly, all of those factors affect the number of women who are able to be screened with the resources available."

At small health departments such as Osceola, which gets $83,000 from the CDC for the program, no one is turned away if they call with a serious problem such as a breast lump, Skizynski said. But most women just want the peace of mind that comes with an annual checkup.

"If our economy stays the way it is, and there are more layoffs, I can see it become more detrimental," Skizynski said.